ANATOMI DAN FISIOLOGI CNS

TRI DAMAI ELOK MIRZA

PEMBAGIAN SUSUNAN SARAF MANUSIA

A. Anatomi 1. Susunan Saraf Pusat (SSP) : Otak (ensefalon) dan medula spinalis 2. Susunan Saraf Tepi (SST) : Saraf saraf kranial dan spinal B. Fisiologi 1. Susunan Saraf Somatik : Mensarafi struktur dindingtubuh (otot,kult,membran mukosa) 2. Susunan Saraf Otonom : Mengontrol aktivitas otot otot dan kelenjar kelenjar bagian dalam tubuh vsera) serta pembuluh darah

SSP
Otak (ensefalon)
Serebrum Telensefalon Korteks Subkorteks Ganglia Basalis Diensefalon Talamus Hipotalamus Subtalamus Epitalamus Batang Otak Mesensefalon Pons Medula oblongata Otak Kecil (serebelum) Paleoserebelum Neoserebelum Arkiserebelum

Sumsum tulang belakang (medula spinalis)

Servikal Torakal Lumbal Sakral

Koksigeal

The Brain
4 Parts
Cerebrum Diencephalon Brain Stem
Pons Medulla Midbrain

Cerebellum

Gray matter surrounded by White matter

Lobus FRONTALIS

Defisit Neurologik

Fenomena Positif

Psikopatologi/ Neuropsikologi Tak punya inisiatif Afek datar

Hemiparesis spastik (kontralateral) Bangkitan motorik fokal Gaze paresis (kontralateral) Adversive fits

(gerakan tonik mata, kepala, Moria (witzelsucht) anggota gerak kontralateral) PARIETALIS Sindroma hemisensorik (kontralateral) Bangkitan sensorik fokal (Jacksonian) Afasia motorik Broca (dominan) Disorientasi ruang Agnosia taktil

Homonim kwadrananopsia bawah

(kontralateral) Hemispasial neglect Hilangnya nistagmus optokinetik TEMPORALIS Homonim kwadrananopsia atas (kontralateral) Bangkitan psikomotor Uncinate fits

Apraksia konstruksional
Afasia amnesik (dominan) Aleksia (dominan) Mudah marah Disinhibisi Defisit memori Afasia sensorik/ Wernicke (dominan)

OKSIPITALIS

Homonim hemianopsia (kontralateral) Gangguan nistagmus optokinetik

Sensasi dan halusinasi visual Agnosia warna Disorientasi visuospasial Agnosia visual Aleksia

The Limbic System

The limbic lobe is located deep in the brain, and makes up the limbic system.

The limbic system is the area of the brain that regulates emotion and memory. It directly connects the lower and higher brain functions. A. B. C. D. E. F. Cingulate gyrus Fornix Anterior thalamic nuclei Hypothalamus Amygdaloid nucleus Hippocampus

Cerebellum
The cerebellum is connected to the brainstem, and is the center for body

movement and balance.

Click image to play or pause video

Cerebellum

Thalamus
Thalamus means inner room in Greek, as it sits deep in the brain at the top of the brainstem.

The thalamus is called the gateway to the cerebral cortex, as nearly all sensory inputs pass through it to the higher levels of the brain.

Thalamus

LESI

LESI CEREBELLUM
1. DISEKUILIBRIUM ASTENIA (otot otot anggota gerak Terasa lembek dan cepat lelah)

PENDULAR (turunnya refleks tendon)

2. DISKOORDINASI MUSKULAR

ASINERGIA (Kesimpangsiuran gerakan) DEKOMPOSISI GERAKAN (Gerakan urutan kontraksi otot secara volunter tdk bisa) DISDIADOKINESIA (gerakan cepat yang arahnya berlawanan) DISMETRIA ( Hipometria jangjauan gerakan volunter yang terlampau pendek) HIPERMETRIA

LESI CEREBELLUM
LOBUS FLOKULONODULARIS

NISTAGMUS

TREMOR

DISARTHRIA

VERMIS ROSTRAL GAIT ATAKSIA (kedua tungkai Melangkah secara simpang siur dan ke2 Kaki ditelapakkan secara acak - acakkan CAUDAL
TRUNKAL ATAKSIA ( badan yg tdk Bersandar tidak dapat memlihara sikap Yang mantap shg bergoyang Goyang)

HEMISFER CEREBELLUM

LIMB ATAKSIA (ataksia yg timbul terutama pd kedua lengan)

LESI THALAMUS

Hypothalamus
The hypothalamus sits under the thalamus at the top of the brainstem. Although the hypothalamus is small, it controls many critical bodily functions: Controls autonomic nervous system Center for emotional response and behavior Regulates body temperature Regulates food intake Regulates water balance and thirst Controls sleep-wake cycles The hypothalamus is shaded blue. The pituitary gland extends from the hypothalamus.

Controls endocrine system

LESI SUBTHALAMUS

GANGGUAN :
Hemibalismus lateral
Gerakan involunter kasar yang nyata dan cepat melempar bagian proksimal lengan dan tungkai

The Brainstem
The brainstem is the most primitive part of the brain and controls the basic functions of life: breathing, heart rate, swallowing, reflexes to sight or sound, sweating, blood pressure, sleep, and balance.

The brainstem can be divided into three major sections.

Click image to play or pause video

LESI MESENSEFALON

Hemiplegi alternans (Hemiplegi kontralat UMN, ggn N III Ipsilat LMN, parese n. XII kontralat UMN, parese n.IX,X kontralateral UMN SINDROMA WEBER : Hemiplegi alternans N. III kiri UMN : Otot tubuh sisi kanan ( N. XII, N. IX dan X) LMN : N. III kiri (midriasis, strabismus divergen, diplopia, ptosis) SINDROMA BENEDICT : Hemiplegi alternans ringan Parese N.III ringan Gerakan involunter lengan & tungkai yg paretik (ringan)

The Pons
The pons is the rounded brainstem region between the midbrain and the medulla oblongata. In fact, pons means bridge in Latin. The main function of the pons is to connect the cerebellum to the rest of the brain and to modify the respiratory output of the medulla. The pons is the origin of several cranial nerves.

LESI PONS

Hemiplegi alternans (Hemiplegi kontralat UMN, ggn N.VI & N.VII Ipsilateral LMN SINDROMA MILLIARD GUBLER : Kelumpuhan LMN yg melanda otot otot yg disarafi N.VI, VII, ipsilat Strabismus convergen

SINDROMA FOVILLE : Lesi yg mengenai serabut kortiko bulbar N.VI (deviasi conjugate)

The Medulla Oblongata

The medulla oblongata merges seamlessly with the spinal cord and creates the base of the brainstem. The medula is primarily a control center for vital involuntary reflexes such as swallowing, vomiting, sneezing, coughing, and regulation of cardiovascular and respiratory activity. The medulla is also the origin of many cranial nerves. N.IX / X

LESI MEDULA OBLONGATA (lateral)

1. SINDROMA MEDULAR LATERAL (SINDROM WALLENBERG) Hemihipestesi alternans, Hipestesi tubuh kontralateral, Hipestesi wajah ipsilateral Ataksia ipsilateral Vertigo Sindroma Horner ipsilateral, nistagmus, gangguan bicara, gangguan menelan

LESI MEDULA OBLONGATA (medial)

2. SINDROMA MEDULAR MEDIAL HEMIPLEGI ALTERNANS = MEDIAL (BASAL) MEDULLARY SYNDROME (DEJERINE SYNDROME)
Disebabkan OBSTRUKSI Cab paramedian Dari Arteri basilaris atau Vertebralis

Lumpuh UMN tubuh kontralateral di bawah leher Lumpuh LMN lidah ipsilateral

CSF: sodium, chloride ions, proteins,

glucose, O2
Liquid cushion for brain and spinal cord Nourishes brain Removes waste Conducts chemical signals between parts of CNS Produced in Choroid Plexuses: group of capillaries surrounded by ependymal cells Forms as a filtrate of blood

CAROTID SYSTEM
( circulus arteriosus Willisii ).

VERTEBROBASILAR SYSTEM

LESI ARTERI VERTEBRO-BASILER

Lesi intrakranial berdasar kelainan motorik

Hemiparese / hemiplegia
Tipika Alternans hemisfere brainstem

Posisi ekstremitas : posisi dekortikasi posisi deserebrasi

Test fungsi batang otak : pernafasan ref. batang otak

Involuntari movement : ggn pd susunan ekstrapiramidal. Ggn. Koordinasi :ggn pd serebellum.